Pains in the neck

A 4-year-old boy is brought into the ED by his parents because they noticed a swelling in his right neck this morning. He was complaining of a sore throat and some neck pain for the past couple of days and the parents didn’t think anything of it until this morning when they noticed the swelling. He has not had any fevers, difficulty swallowing, drooling, hoarseness or difficulty breathing. He has not received all of his vaccinations due to a viral illness during his last visit to the Pediatrician’s but the parents say he is an otherwise healthy child.

On exam, you note an area of erythema inferior to his right jawline that is tender and swollen. You place a probe on the patient’s neck, and obtain the following image.

**Attention: Original questions posted on March 22, 2016 were revised on March 25, 2016.

If you want to see YOUR image included in the next Image of the Month, please email interesting stills and/or clips in addition to a small blurb on the patient to Lorraine Ng at PEMFellowscom@gmail.com.